scholarly journals Biochemical predictors of structural hypothalamus–pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism

Author(s):  
S. Cipriani ◽  
T. Todisco ◽  
N. Ghiandai ◽  
L. Vignozzi ◽  
G. Corona ◽  
...  

Abstract Purpose Organic conditions underlying secondary hypogonadism (SH) may be ascertained by magnetic resonance imaging (MRI) of the hypothalamic–pituitary region that could not be systematically proposed to each patient. Based upon limited evidence, the Endocrine Society (ES) guidelines suggest total testosterone (T) < 5.2 nmol/L to identify patients eligible for MRI. The study aims to identify markers and their best threshold value predicting pathological MRI findings in men with SH. Methods A consecutive series of 609 men seeking medical care for sexual dysfunction and with SH (total T < 10.5 nmol/L and LH ≤ 9.4 U/L) was retrospectively evaluated. An independent cohort of 50 men with SH was used as validation sample. 126 men in the exploratory sample and the whole validation sample underwent MRI. Results In the exploratory sample, patients with pathological MRI findings (n = 46) had significantly lower total T, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prostate specific antigen (PSA) than men with normal MRI (n = 80). Receiver Operating Characteristics analysis showed that total T, LH, FSH and PSA are accurate in identifying men with pathologic MRI (accuracy: 0.62–0.68, all p < 0.05). The Youden index was used to detect the value with the best performance, corresponding to total T 6.1 nmol/L, LH 1.9 U/L, FSH 4.2 U/L and PSA 0.58 ng/mL. In the validation cohort, only total T ≤ 6.1 nmol/L and LH ≤ 1.9 U/L were confirmed as significant predictors of pathologic MRI. Conclusion In men with SH, total T ≤ 6.1 nmol/L or LH ≤ 1.9 U/L should arise the suspect of hypothalamus/pituitary structural abnormalities, deserving MRI evaluation.

Author(s):  
Hongzhang Zhu ◽  
Shi-Ting Feng ◽  
Xingqi Zhang ◽  
Zunfu Ke ◽  
Ruixi Zeng ◽  
...  

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.


2021 ◽  
Vol 14 ◽  
pp. 117954762198967
Author(s):  
Van Trung Hoang ◽  
Cong Thao Trinh ◽  
Hoang Anh Thi Van ◽  
Thanh Tam Thi Nguyen ◽  
Vichit Chansomphou ◽  
...  

Balo’s concentric sclerosis (BCS) is a rare demyelinating disease known as Multiple Sclerosis (MS) lesion type III. It is a disease of the white matter of the brain characterized by a round lesion with variable concentric myelinated and demyelinated layers, appearing as “onion bulb.” We present a case of BCS and discuss the imaging findings and management strategies of this disease. A 26-y-old male developed headache, weakness, and numbness of limbs. Magnetic resonance imaging (MRI) showed concentric lamellar like demyelinating lesions at the subcortical regions. The patient’s neurological symptoms were consistent with the MRI findings.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seiya Ota ◽  
Eiji Sasaki ◽  
Shizuka Sasaki ◽  
Daisuke Chiba ◽  
Yuka Kimura ◽  
...  

AbstractWe investigated the prevalence of magnetic resonance imaging (MRI) findings and their relationship with knee symptoms in women without radiographic evidence of knee osteoarthritis (KOA). This cross-sectional cohort study included 359 Japanese women without radiographic evidence of KOA (Kellgren‒Lawrence grade < 2). All participants underwent T2-weighted fat-suppressed MRI of their knees. Structural abnormalities (cartilage damage, bone marrow lesions [BMLs], subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the whole-organ MRI score method. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Participants were divided into early and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms. Cartilage damage was the most common abnormality (43.5%). The prevalences of cartilage damage, BMLs, subchondral cysts, bone attrition, meniscal lesions, and synovitis were higher in patients with early KOA than in those without. Synovitis (odds ratio [OR] 2.254, P = 0.002) and meniscal lesions (OR 1.479, P = 0.031) were positively associated with the presence of early KOA. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 694.2-694
Author(s):  
R. D. Vargas Ruíz ◽  
J. A. Gómez Rosero ◽  
C. Muñoz ◽  
D. Jaramillo Arroyave ◽  
L. Hernandez ◽  
...  

Background:muscle involvement is frequently reported in polyarteritis nodosa (PAN), mostly as myalgia, muscle swelling, and gait difficulty due to intramuscular arteries involvement, peripheral neuropathy, or myositis with slightly or no elevation of muscle enzymes. Magnetic resonance imaging (MRI) findings of compromised muscles have been reported in isolated cases, mainly as a limited form of PAN, however, muscular involvement patterns in MRI of patients with PAN have been recently describedObjectives:to describe MRI of legs findings in patients with PAN in a tertiary center from Medellin-Colombia.Methods:it was performed a retrospective cross-sectional descriptive study of 15 adult patients who were clinically assessed as having PAN and who had undergone MRI of legs between January 2011 and December 2019. Characteristics already informed in previous studies, affected structures (muscle, subcutaneous tissue, and bone) and pattern of hyperintensities were described as diffuse pattern (signal alterations affecting the entire area of the involved muscle), patched pattern (areas of hyperintensities alternating areas of normal muscle signal intensity), and fluffy nodular pattern or cotton-wool appearance (round hyperintense lesions with fluffy margins centered on blood vessels).Results:clinical characteristics:myalgia, especially calf pain, was the most frequent muscular complaint; other clinical manifestations were: constitutional symptoms (80%), arthralgias or arthritis (50%), mono/polyneuropathy (33%), subcutaneous nodules (33%), livedo reticularis (20%), lower limbs ulcers (13%), abdominal symptoms (13%), and purpura (7%).MRI findings:bilateral muscular edema was found in all patients (100%), fatty infiltration (20%), edema of the subcutaneous cellular tissue (20%), and muscular atrophy (13%) were also described. A diffuse pattern occurred in 46% (n=7) of patients (figure panel A), a patched pattern (figure panel B) in 46% (n=7), and a fluffy nodular pattern or cotton-wool appearance (figure panel C) in 6% (n=1). The most frequently affected muscular group was gastrocnemius and soleus (67%), followed by anterior tibialis (27%), plantar, long peroneus, first finger flexors, and long flexors only affected in 7%. Bone involvement was found in 53%, being the tibia the most affected, followed by the fibula and the calcaneus. MRI led to guide the site of muscle biopsy to prove histological medium-size vasculitis in half of the patients.Conclusion:in patients with PAN suspicion who have muscular complaints, especially calf pain, MRI arises as an important diagnostic tool, and also as a guide to muscular biopsy to prove vasculitis. The patterns associated with PAN are diffuse, patched or fluffy nodular hyperintensities in gastrocnemius and soleus with or without bone compromise.References:[1]Kang, Y. et al. Muscle involvement in polyarteritis nodosa: Report of eight cases with characteristic contrast enhancement pattern on MRI. Am. J. Roentgenol. 206, 378–384 (2016).[2]Hofman DM, Lems WF, Witkamp TD, Putte VD, Bijlsma JW. Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa. Clin Rheumatol 1992; 11:402–404.FigureDisclosure of Interests:None declared


Author(s):  
Sebnem Karasu ◽  
Atilla Hikmet Cilengir ◽  
Irfan Ocal ◽  
Serpil Aydogmus

Background: Vaginal adenosis is a rare clinicopathological entity which refers to the presence of glandular endometrial tissue in the vaginal wall. Case report: A gravida 46-year-old woman was presented to the gynecology department with symptoms of chronic pelvic pain. Maternal Diethylstilbestrol (DES) usage has been proven effective in the development of vaginal adenosis. It can also be idiopathic. Its sonographic or magnetic resonance imaging (MRI) findings have not been described in English literature previously. Conclusion: Here, we report the clinical, transperineal ultrasonographic (US) and MRI findings of a pathologically proven case of vaginal adenosis.


2018 ◽  
Vol 70 (5) ◽  
pp. 1383-1387 ◽  
Author(s):  
T.M. Granato ◽  
L.P. Mesquita ◽  
R.C. Costa ◽  
J.P. Andrade Neto ◽  
P.C. Maiorka

ABSTRACT The aim of this report was to describe the magnetic resonance imaging (MRI) and pathological features of a canine mixed glioma. A 12-year-old boxer male dog was presented for necropsy along with data from an MRI evaluation conducted ante-mortem. The images were examined and showed a poorly demarcated prosencephalic lesion, hyperintense on T2W images, hypointense on T1W images and heterogeneously hyperintense on T2W FLAIR images. There was mild nonuniform contrast enhancement, apparent midline shift, moderate perilesional edema and marked distortion of the adjacent lateral ventricle. The brain was evaluated macroscopically, microscopically and immunohistochemically. Grossly, there was a poorly demarcated soft mass, with areas of hemorrhage, within the left parietal and temporal lobes. Histologically, there was a densely cellular mass composed of two geographically distinct populations of neoplastic cells. The first population was composed of small and round cells organized in a honeycomb pattern. The second population constituted of intermingled streams and bundles of neoplastic cells that were strongly immunolabeled for glial fibrillary acidic protein (GFAP). The diagnosis of a mixed glioma was based on MRI findings, and mainly on histological and immunohistochemical findings.


2017 ◽  
Vol 11 (1-2) ◽  
pp. 8 ◽  
Author(s):  
Fikret Balyemez ◽  
Ahmet Aslan ◽  
Ibrahim Inan ◽  
Ercan Ayaz ◽  
Vildan Karagöz ◽  
...  

Introduction: We aimed to introduce the diagnostic value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) for distinguishing benign and malignant renal cystic masses.Methods: Abdominal DWI-MRIs of patients with Bosniak categories 2F, 3, and 4 cystic renal masses were evaluated retrospectively. Cystic masses were assigned as benign or malignant according to histopathological or followup MRI findings and compared with apparent diffusion coefficient (ADC) values.Results: There were 30 patients (18 males and 12 females, mean age was 59.23 ± 12.08 years [range 38‒83 years]) with cystic renal masses (eight Bosniak category 2F, 12 Bosniak category 3, 10 Bosniak category 4). Among them, 14 cysts were diagnosed as benign and 16 as malignant by followup imaging or histopathological findings. For the malignant lesions, the mean ADC values were lower than for benign lesions (p=0.001). An ADC value of ≤2.28 x10-6 mm2/s or less had a sensitivity of 75% and a specificity of 92.86% for detecting malignancy.Conclusions: ADC can improve the diagnostic performance of MRI in the evaluation of complex renal cysts when used together with conventional MRI sequences.


2012 ◽  
Vol 45 (4) ◽  
pp. 500-504 ◽  
Author(s):  
Luciana Cristina dos Santos Silva ◽  
Luciene Mota Andrade ◽  
Ivie Braga de Paula ◽  
Leonardo Campos de Queiroz ◽  
Carlos Maurício Figueiredo Antunes ◽  
...  

INTRODUCTION: There is no study relating magnetic resonance imaging (MRI) to ultrasound (US) findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS: Fifty-four patients (mean age 41.6±13.5years) from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma). RESULTS: Forty-seven (87%) of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%), MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1%) of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS: Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI) is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.


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